ER s03e16 Episode Script

Faith

Previously on ER - When are you coming back? - The hearing is in a couple of weeks. Nurse Hathaway is doing fine on her own. - Why two women on one night? - Scheduling mix-up. - I thought we were going out? - Before or after the basketball game? I just took out your appendix. I'm afraid of liking you too much. - We're going to intubate him. - He doesn't want that. Intubate him. - Mom? - Oh, did I wake you? - What are you doing? - I'm making you breakfast. Where's the coffee? - How are you feeling? Sleeping okay? - Like a baby. - No nightmares? - No. - It would only be natural. - I see worse things at work every day. - Today's the big day, right? - The test? No, find out about your job. They suspended me. I might not get my job back. - Those eggs done? - No, still too runny. - I like them runny. - Just another couple of minutes. - What test? - Medical school admissions test, Mom. - I thought you gave up on that. - No. Big commitment. Here we go. Perfect. - Doctor. That would be something. - I could do it. - I knew you could. - Why do you always do that? Make me feel incapable, stupid. - I just said that you could do it. - I wish you could believe in me. You're always criticizing me, belittling me. Why didn't you tell me I could be an astronaut? - Did you want to be that? - I wanted you to tell me I could. Fine. Go be an astronaut. I'm your mother, I love you whoever you are: Doctor, nurse, housewife. - Oh, right, housewife. - You're the one that holds you back. You always quit things. You never think you're good enough. - I finish things. - Ballet, cheerleading, the flute. - I was 13! - Business school, your own wedding. - I finished nursing school. - Right. Exactly. You have a great job you're good at. Why is the grass suddenly greener? I'm proud of you. Why aren't you proud of yourself? Carla! Carla! I was coming to see you. I didn't know you had to be at work this early. I don't. I'm sorry I haven't called. A lot of stuff came up. I just had a lot of stuff going on. - I had a minor surgery and - Sorry to hear that. Are you okay? Yes. It was just my appendix. - What about you? - What do you want? - We need to talk. - I told you I was pregnant weeks ago. Then nothing. No phone calls, no coming by to see how I was doing. I got the point. I wasn't trying to make a point! I realize there's going to be a baby, and he will be my responsibility too. I just needed some time to think about this. It's not the way I would've planned it, but you're not doing this alone. - Are you going to marry me, Peter? - That's not what I'm saying. What are you saying? Are you going to stop by and change some nappies and stay for some Kodak moments? The child will need a good school and a nice place to live. - Can't I provide that? - I can help, Carla. Money. So that is what this is all about. Yes. That among other things. The child will need a man in his life. Who says the baby will not have a man in its life? Are you seeing somebody else? Peter, you and I have known each other for a very long time. I never expected you to marry me. I never expected a damn thing from you. You care about you. And that is the way it's always going to be. But it's comforting, really. It's one of the few constants in my life. Don't worry. This baby is going to be fine. Plenty to eat, nice clothes, a man to call dad. I'll take care of that. You go back to worrying about yourself. That's what you do best. Dr. Benton! First day back. How's the incision healing? - I'm fine, Carter. - You shouldn't be back yet. Have you finished the whole course of antibiotics? Hi, Peter, how's the scar? I made a Rocky-Davis incision, running stitch, McBurney's point. When the hair grows back, the itching starts. You're going to show us your scar, Peter? Let's see! Yes, let's take a look. I did it one-handed. - Stop, Carter! - That's a shame. It's a great job. Good thing I took pictures. - What is that, a mole? - Good morning. What are you doing? - Good God, what is that? - Benton's appendix in a jar. - Wow, they shaved him good. - Dr. Carter we're still backed up. - Okay, I'm on my way. - Carter looks beat. - He was on again last night. Surgical interns still cover Dr. Gant's shifts. - Sounds like a 90-hour week. - More like 95. Thank God for Pediatrics. What is that all about? Nurses and management are still at the table. Contract expires at midnight. Mark, paramedics are pulling up with a female, 35, respiratory failure. - Duty calls. Hey, lunch? - Lf you're buying. - Carol's back today? - Yes. Investigation is done, Nursing has the report. - Have you seen it? - No. - How's she doing? - She says she's fine. Okay, Jeff, thanks. Nothing yet. They're still at it. - I don't want to walk a picket line. - Not in February. - We stay firm. - Easy for you to say. They'll settle. They can't run the place without us. That's what the air traffic controllers said before parking cars for a living. One, two, three. Down's patient, 37. Found in bed with respiratory distress. Resps shallow at 30. BP's 100/50. Mom said she's had an infection, but she never fully recovered. - Where's the mother now? - She followed in her car. Two-plus pitting edema! Louise, I'm Doctor Greene. You have a little trouble breathing? We're going to make you feel better. She's scared. She held my hand all the way. Louise, can you tell me what day it is? You can't tell me. Dr. Doyle, can you take a listen? - Chuny, come and hold Louise's hand. - You bet. CBC, lytes, EKG, chest film, O-2, 6 liters by mask. Hi, Louise. My name is Chuny. S3 gallop and mitral regurg? Possible cardiomyopathy. - Mark, she's trying to say something. - Louise do you need something? - What's wrong? - Where's my mom? Your mom is coming real soon. Okay? Don't worry. You can just relax. You're doing great. Human Resources reviewed your incident report in ER procedures. They passed our recommendations to the Safety Committee. - And? - They agreed with us. Your mistake was a result of systems problems and not negligence. There will be a written warning in your file for a year. The three weeks you missed will be deducted from your vacation time. - That's it? - You preferred a public flogging? You can start back today. - You don't have to start back today. - No, thanks. I'm okay. I better get back to work. - La Boh áme! - You make it sound like a bacteria. - What is it? Like five hours long? - Forget it. I'm not an opera fan. Marcus Roberts tickets on the contrary I got it, Greg. You don't want to go. Fine. Is La Boh áme the one where they lop off the nuns' heads at the end? It's set in Paris. There's star-crossed lovers and artists. Jeanie, hang on. If you want to go, we'll go. - Don't do me any favors. - I'd love to go. I just thought we could do something spontaneous. - Opera? - I have to get back to my patient. Let's hang out anyway. We'll order food. Watch the Bulls-Warriors game. You think you're charming, but you're not. Lunch then? Please let me buy you lunch. Jeanie! - That's one boggy heart. - It's taking up most of her chest. EKG shows ST and T wave changes. What do you want to do? Get an echo and page Cardiology. - Mark, Louise's mother is here. - Hi, Mrs. Cupertino, I'm Mark Greene. - How's Louise? - Not good. Her heart isn't pumping well, and her lungs are filling with fluid. - Can I say hello? - Yes, sure. - Hello, Louise. It's Mommy. - Hi, Mommy. Are you okay? You're not scared, are you? I brought some of her things. Just to make her feel more at home. I'll just put this quilt on her. - Make sure she's good and warm. - Mrs. Cupertino, can I speak to you? She had trouble understanding me. Can she communicate? Oh, yes. She likes to talk. Is she suffering from any dementia or Alzheimer's? No, she's a good girl. Echo's on its way. Is she competent to make her own medical decisions? No. I'm her guardian. Louise can't make decisions on her own. You are aware that Louise's condition is very serious. Louise may need a heart transplant. Is she on the waiting list? - The list? No. - She's not? They wouldn't put her on the list. They wouldn't put Louise on the heart transplant waiting list? My daughter is mentally retarded, doctor. Peter, sorry to keep you waiting. Welcome back. We've missed you. I was surprised not to see my name on today's schedule. - How are you feeling? Well rested? - Yes. And mentally? Feeling sharp? No post-operative depression? - No. - No depression of any kind? Dr. Hicks, if you're asking if I can perform my duties adequately, I can. I'm asking how you are, Peter. - I'm fine. - Okay, then, let's see what we've got. It's two Port-A-Caths, a circumcision and nevus removal. A mole? They can't refuse to put her on the list because she has Down's. - There must be other circumstances. - She's a retard, so why bother. Dr. Kayson. Dr. Doyle. Echo shows left ventricular dilatation with an ejection fraction of 18%. There are also signs of wall-motion abnormality. I'm worried about her breathing. We've given her 40 Lasix, she's still struggling. - I'd like to try a vasodilator. - Sure. Do whatever you can to make her comfortable before you release her. She will be a lot happier at home with her mother. She needs a heart transplant, right? That would be the standard operative course, yes. Louise's mother told us that she's not on the transplant list. UNOS can't refuse to put a patient on the list because of a birth defect. - UNOS didn't refuse, we did. - Cardiology? Hospital Transplant Committee. We chose not to submit her name to UNOS. That's a death sentence. She's a 37-year-old Down's patient. She is lucky to have lived this long. - Down's patients can live to be 60. - That's extremely rare. - What are you, an intern? - First-year resident. Why don't we step in here? Dr. Kayson, Dr. Doyle's expressing a frustration I think we all feel. Louise is an obvious candidate for the UNOS transplant list. I'm a cardiologist. I'd like nothing better than to give her a new heart. If you have a problem with the decision, speak to the committee. Short of that, send her home. Nice guy. - Carol, are you back? - Yes. Thank you, Jesus. Hey, you all, Carol's back. - Carol, you're back. - Starting now. - We've missed you. - Thought we'd never make it. - Did they dock your pay? - No, just some vacation time. - It's been a disaster without you. - A complete zoo. - I didn't do that bad a job. - No, you did worse than that. Call union meetings after work, Haleh. - Carol's back. - Oh, thank God. - We'll talk to you at lunch. - We'll catch up later. We're glad to have you back. Are you okay? I'm sorry to disappoint everyone's expectations, but I'm fine. It started a few hours ago after breakfast. - Is it a sharp pain? - No. Sort of all over. - I just started my morning walk. - Any recent illness? I take digoxin for atrial fibril I can never say that word. - Fibrillation. Anything else? - No. - What did you have for breakfast? - The usual. Three fried eggs, bacon, glass of buttermilk, toast and jam. The American Heart Association breakfast. Don't lecture me. My mother had the same every day in her life. She died last year at 96. Car accident. - Vitals? - 130/90. - Heart rate, 110. Resps, 24. - Did Dr. Weaver get a CBC? Yes. Crit's 53. White count is 12.2. - You drink enough fluids? - Is that what's wrong with me? - Too early to tell. Chest film? - Not back yet. I'm going to call for a surgical colleague to come and take a look. Her breathing's improved. Hey, Louise, feeling better? - For you. - She likes to share. - Malibu Barbie was my favorite too. - I was more partial to Ken. - You don't like Ken? - Too pretty. I'm with you. Ken is trouble. Louise, can you hold on to her while I do my work? She misses her friends since she got sick and had to move back home. - She had her own place? - An apartment above the garage. And she had a job at the Jewel helping people with their groceries. Father even let her be an altar girl at the church. Everybody loves her. Excuse me, Dr. Greene. I got that list from upstairs. Thanks. Transplant Committee? Who are the bastards? Excuse us. Your attitudes can get in the way of achieving your goals. You're not going to vote for me for homecoming queen this year? Like that, you mean. - Recognize any names? - One. - The vanquished return victorious. - Hey, Doug, you miss me? You have no idea. I heard they clipped you for some vacation time. I never take it anyway. I think I have a couple of years saved up. This place is a mess. How are you doing? No complaints. Today is the 20th, isn't it? - I think so. - MCATs are this afternoon. - Are you going? - Got to work. - All that saved-up vacation time? - It was a stupid idea. Four years of med school if I ever get in. All that debt. I would be 50 by the time I got out. What's the point? I could bring you coffee in the middle of the night to the med library. I could teach you how to cheat on the biochem exams. - Doug. They need you at Pedes. - Okay. Think about it. - Carter, where have you been? - Getting some food. Do you have a spoon? No. Anspaugh's in there with your patient. Said you paged him. - I paged Dr. Hicks. - You got Anspaugh and the rounds. - What do you hear, Edson? - Rales at the base of the lungs. I'm sorry to have dragged you down here, I paged Dr. Hicks for a consult. Dr. Hicks is in surgery, and we were on the prowl for an interesting case. - We heard you had a surgical abdomen. - That's my suspicion. Pain vague and diffuse, very little tenderness to palpation. Chest films show bibasilar effusions. Rales heard on auscultation. Would you consider this a surgical patient, Dr. Edson? - No, I'd bet on CHF. - Yes, but I was more concerned with the CBC. Previously diagnosed with atrial fibrillation? Her diet? I'd assume that she went into fib or ate a salty meal. And that was enough to push her into congestive heart failure demonstrated by the rales and chest effusions. The diffuse abdominal pain is probably due to congestion in the liver. In other words, congestive heart failure secondary to a-fib. - Wouldn't you agree, Dr. Carter? - Yes, that sounds about right. Is Dr. Pomerantz available? I'm Mark Greene from the ER. - Does she know you? - Yes, Steph, I do. Hi. - You got a minute? - Sure. Just move those, put them anywhere. What can I do for you? You're on the committee that evaluates prospective transplant patients? I have a dying patient, Louise Cupertino. Dr. Kayson tells me that she was denied access to the UNOS list. Kayson made it sound like she wasn't excluded for medical reasons. - What do you want? - Kayson said yes. If I can get you and another person to sign on, Louise can get a new heart. Our decisions must be unanimous. But I'm the one that turned Louise down. Do you know how many people die each year because of lack of organs? - 3500. - She had a job, an apartment. Is her life less worthy than a smoking businessman with wife and kids? Don't patronize me. I agonized over this. Louise has an IQ of 40. She can't comprehend the surgical risks. She had a job, but she was always late. She can't tell the time. How is she going to adhere to the rigors of the post-transplant regime? Her mother will make sure she gets her meds, get her where she needs to go. She's a 120-pound 8-year-old. We do the operation, and assuming she doesn't die for lack of care she's in a state home in two years. And her mother's adamant she not end up in a home. Those are logical reasons we give ourselves so we can sleep at night. Louise can make people smile, she can laugh and cry and hold someone. I have an 8-year-old. If she never grew a day older I would still cherish every moment we've spent together. It's not our place to decide whether Louise lives or dies. She has as much right to be here as you do or I do. Nina, don't let her die. - I'm freezing. - I thought you liked picnics. I love picnics. I'm just not used to having to thaw my sandwich first. Where's your sense of spontaneity and romance? - This dip is frozen solid. - It's a p ðt Á. It's a brick. Okay, I'm sorry. I was wrong. You're very romantic. You're very spontaneous and crazy. Please put your parka on before you freeze to death. - I'm fine. - You can't be fine. It's 10 degrees. I think we should start sleeping together. - What? - Sex. I think we should have some. In fact, I think we should have a lot. - Are you sure? - Hell, yes, I'm sure. This isn't a joke, Greg. No, it isn't. Jeanie Boulet would you please sleep with me? - How is she? - Her breathing is worse. - How is the pain? - It hurts. - Hi, who are you? - Her daughter, Yolanda. She's so stoic. If she says it hurts, it must be awful. Oh, God! Let me do a repeat CBC and a blood gas. - Do you want to page Anspaugh? - No. Call Dr. Hicks. Tell her that I need her down here right away. My fianc Áe has been begging me for years to get this thing off. - Betadine. - I'm not very religious, but her family wouldn't even consider the marriage if I didn't convert. It's cold. I wouldn't have started dating her if I knew this was part of the deal. Lidocaine. You'll feel a small prick in the area to be anesthetized. - Please don't move. - Good, you haven't started yet. I have three eager pre-med students from Evanston. I thought they might enjoy watching you perform a circumcision. - Don't mind us, sir. - I'm converting to Judaism. - Dr. Hicks, phone call from the ER. - Make them feel welcome. You're in very capable hands. Number 15 blade. - I'm Dr. Ross. Someone paged me? - I paged you. Samantha Ewing. I've got a CF kid up here, Jad Heuston. Know him? He's been on a respirator for some weeks on his mother's request. Today's his 18th birthday, and he wants off. - Why page me? - He wants you to do it. Hi, Norma. Hi, Katy. Happy birthday, Jad. His first act as an adult was to ask to be removed from the respirator. I explained the dangers, but he insisted. Are you still sure? The nature of his disease and the time he's been on the machine may cause him to die after some minutes. Can you talk to him? What's his tidal volume? Is this what you really want? Have you said your goodbyes? Yes. Okay. All right, buddy. You know the drill. I'm going to count to three. You're going to take a deep breath. You're going to blow out while I pull. Can you give me a hand with this? I love you. All right. Here we go. On three. Ready? One, two, three. Blow, blow, blow. Is he going to be okay? Good afternoon. What could be so important? of abdominal pain five hours ago. Pain was vague and diffuse. Belly wasn't too tender. Takes digoxin for a previously diagnosed atrial fib. Rales. Chest x-ray shows basilar infiltrates bilaterally. Dr. Anspaugh was here, and he diagnosed congestive heart failure diffuse abdominal pain due to congestion in liver secondary to CHF. - We gave her 40 of Lasix. - Good story. What's the problem? - I think Dr. Anspaugh is wrong. - Page Dr. Anspaugh, please. - He's still at lunch with Weaver. - Quickly. You have a better story. Her abdominal pain is worsening. Resps are 39, and she's acidotic. When she came in, she was dehydrated. So why's fluid on her lungs? The pain isn't explained by congestive heart failure. It doesn't add up. - And what is your thinking? - She suffers from atrial fibrillation. That puts her at risk for developing clots. She threw an embolus and it's blocking her small bowel. - What is going on? Dr. Carter believes that you diagnosed his patient incorrectly. Pain is worsening, resps are up to 39 and she's acidotic. CHF made sense earlier, but I think she has ischemic small bowel disease secondary to an embolism in the mesenteric artery. - Pretty good story. - Damn it! I diuresed her. Normal saline, 200 cc's per hour. Call the O.R., we're moving her now. - What's happening? - Your mother needs an operation. She's going to be just fine. - Dr. Anspaugh, can I assist? - You're going to do it. - Perform an embolectomy? - Yes. You're the only one here who seems to know what they're doing. - It's going to fall. - No, it's not. - Yes, it is. - No, it's not. - She looks like she's feeling better. - Yes, she ate a little bit. - Seems to be breathing okay. - Who's her friend? My brother. Mom brought him down, I figured Louise needed some company. Hey, Jimmy, say hello to Dr. Greene. He's my boss. - Hi, Jimmy, how are you? - What did they say? Come here. Psych doesn't think she can handle post-op regime and that the mother will be around long enough to get her through it. That's a lot of crap. She can go to a group home. - Jimmy takes classes out of Glenkirk. - Mom doesn't want her in a home. She has guardianship. I called Loyola and Rush. They both have transplant centers. Maybe they can get her on the list. - Mark. - Dr. Doyle, this is Dr. Pomerantz from Psych. She's the one that evaluated Louise. Hi, Louise. How are you doing? Mrs. Cupertino. - She's doing better. - She's out of heart failure. You need to fill this out. Transplant candidate registration form. She can't get on the network without it. Kayson filled out most of it. I need today's history so that I can rank her. Get it back to me soon. Nice meeting you. Nina thank you. Jad, why don't you come and go? You take off during the day and do what you want to do and when you come back, we hook you up with IV antibiotics. We get a PT to pound your chest in the morning. - No, thanks. - It's a lot more comfortable. You might even squeak out a couple of extra weeks out of this thing. I said no, thanks. All right. Here is my beeper number. That's my home number. You can call me anytime, day or night. Let's go. Thanks. - Where are you going? - Anywhere but here. Sorry, Dr. Ross. I raided the cafeteria. Bought every cake they had. Ladies! Here's your cake. - What's going on? - The nurses got their new contract. - Did they get what they asked for? - Current employees are protected but the hospital wants to replace RNs with unlicensed technicians. - Technicians? - It's the wave of the future. - Come on, doctor. Dance. - No, thanks. No, I'll get the next song. Have you seen Carol? She changed her mind and went home before lunch. - I'm starving. Want a piece of cake? - No, thanks. Hey, I just dropped off all the paperwork with Nina Pomerantz. Louise will be on the transplant list tomorrow. All we can do is wait. - Where's your brother? - In the lounge watching TV. Louise's mother won't sign the surgical release. Kayson was just here. She doesn't want Louise to have the transplant. Did he explain that she will die without the transplantation? Twice. Then I tried. She wants to take her home. Mrs. Cupertino you don't want Louise to have the operation? I was 41 years old when Louise was born. I knew right away that something was wrong. I couldn't see Louise, but I saw the doctor. He was frowning and snapping his fingers over the little bassinet. They took her away before I had the chance to see her. I thought maybe she'd died. Maybe the umbilical cord had gotten wrapped around her neck. Nobody told me anything. Then they put me in another room with mothers and their babies. And I waited there for hours until the doctor finally came back. He looked very sad. He told me that Louise was mongoloid. He said that I should put her in a state hospital and never ever see her again. She will die if she doesn't have this operation. We all die, doctor. Louise has been the light of my life for 37 years. God blessed me with this wonderful girl, and I wouldn't change a thing. I'm not going to be here much longer. I'm her whole life, just as she has always been mine. There are group homes. Places where she can make friends enjoy life, even if it is for only a few more years. I went to a home 20 years ago when my husband died. If something happened to me, who would take care of her? And there were women there like her with Down's wandering around half-naked. They didn't even know their names. I couldn't put Louise in a place like that. You want to save people, doctor. If my daughter dies, you'll lose. But I'm not afraid of death. Jesus is there, waiting for us. To hold us and bring us into the light. To show us the kingdom of heaven. And if Louise dies before I do I know where I will see her next. With angels where she belongs. Because she is an angel. My angel. - Something new? - Mesenteric embolectomy. - Who's doing it? - Dr. Carter. - Dr. Carter! - Just rolled the woman into 3. Sweet God in heaven. I hope someone's helping him. We're putting in a Port-A-Cath, a catheter used to deliver chemotherapy. Should you pursue a career in surgery, you'll perform this procedure dozens of times in your first year of residency. The position of the catheter must be checked with a fluoroscope. Does everyone know what a fluoroscope is? Here it is. Can I steal Debbie? We need her in O.R. 3. What's going on? Dr. Carter is performing a mesenteric embolectomy. - By himself? - Anspaugh and Hicks are supervising. - What's the score? - Bulls are down by one. Oh, what a nice shot. I let a kid with CF leave the hospital today. He's 18 years old. He went off to die with his girlfriend. Didn't want any help. - Could you have done anything? - No, not really. I spent the day trying to get a CHF patient with Down's on the heart transplant list. Any luck? Mother wouldn't sign the surgical release. Fine couple of doctors we are. Do you remember when we were going to change the world? No. I was always in it for the money. All right. See you later. - Want to grab a pizza? - No, I have to be someplace. Anybody I know? No, I'm just helping out an old friend. See you. - Hi. - Are you ready to go? - Where? - Dinner at Morton's and La Boh áme. - I said we didn't want the tickets. - I said you were wrong. - I'm not dressed, we'll be late. - You can tell me what we missed. - What about the basketball game? - Taping it. You don't have to prove anything, Greg. - I don't? - This has all been pretty fast. We can slow it down. Make sure it's right. So this means that we don't have to go to the opera? No, seriously. Can we just slow it down? - Sure. - Okay. - Hey. What are you doing here? - Waiting for you. - Have you been waiting long? - Oh, a while. - So you took it? - Yes, I did. - And? - I knew a lot more than I thought. There were a lot of people taking it. Kids. I felt about 100 years old. They seemed confident and smart. I guessed a lot. - I bet you did great. - Thanks. - Was your day okay? - You know, just saving lives. - Have you seen my mom? - I banged the door, nobody answered. Do you want to come in? I'll make some coffee. No, I can't. I'm up early. I'm going to go home. Okay. - See you tomorrow then. - Yes. Doug, I know everyone is worried about me but I'm fine. I was scared in that store, but I'm okay now. - Why did you take it? - The MCATs? For me. I just wanted to see if I was good enough. You are. I love this place. You should, you're a wonderful surgeon. You belong here. You know, you were right this morning. I haven't slept much in the last few months since Gant's dying. Before that, me almost killing that baby and Keaton not recommending me Six months ago, I thought I was invincible. And now I don't even I don't even know. I guess life isn't working out the way I thought it would. You're not responsible for Dr. Gant's death, Peter. I could have stopped it. Told him he was doing well, encouraged him. I wish I could tell you that it was all intentional. That it was part of some master plan that I had going on. Truthfully, I never even thought about Gant. He was just an intern. I was more involved with my career, my ambitions. We all have to find our own way, Peter. You're not invincible. You're a young doctor. You're learning, making mistakes, saving lives. It takes a lifetime. You just have to have faith. Go home. You have got a busy day tomorrow. More circumcisions and Port-A-Caths? No. I've signed you up for a lap choly at 6 and I would appreciate it if you'd assist me on a splenectomy at 11. Thank you, Dr. Hicks. You're welcome, Peter. See you in the morning.